1 -  Effects of prenatal exposure to alcohol
      Some of the autistic individuals whose brains were
examined by magnetic resonance imaging (MRI) and
at autopsy may have been exposed to alcohol during
gestation.  Reports of decreased Purkinje cell density,
abnormalities of the inferior olives, anomalies of the
cerebellar vermis, and thinning of the corpus callosum
in autism are similar to neuropathology found in
children exposed to alcohol in utero [1].  Roebuck et
al. (1998) described a range of severity in damage
associated with fetal alcohol syndrome (FAS) and
milder conditions caused by prenatal exposure to
alcohol (PEA).

     Toxic effects of prenatal alcohol and other drugs
have been identified as medical conditions associated
with autism in some cases.  Nanson (1992), Harris et
al. (1995), Aronson et al. (1997), and Church et al.
(1997) have reported autism, Asperger syndrome,
and autistic behaviors in children with fetal alcohol
syndrome [2-5].  Davis et al. (1992) reported three
children who met the criteria for autistic disorder who
were exposed to both cocaine and alcohol during
gestation [6].

     Alcoholism is often a closely guarded secret in
families.  Habitual use of alcohol and other drugs
during pregnancy ought to be carefully sought out in
the prenatal history of children with autism, especially
in research aimed at finding genetic predispositions
for autism in families with more than one
developmentally disabled child.  Iosub et al. (1981)
followed 63 patients with FAS from birth to 23 years of
age [7].  Eleven families had more than one affected
child, with increasing pathology in successive children.
 The older less-severely-affected children might well
be described as representing some broader
phenotype of developmental disability, as has often
been presumed significant in families with more than
one autistic child.

     Jones and Smith (1973) introduced the term fetal
alcohol syndrome (FAS), although they cite evidence
back to early Greek and Roman civilizations that
indicate long-time awareness of the risk of alcohol to
the unborn child [8].  Prenatal exposure to alcohol
leads to craniofacial and ocular anomalies specific
enough to identify some children with FAS, but these
features may be minimal in others.  Exposure to
alcohol during gestation results in a spectrum of
disabilities that can be mild or severe.  Behavioral
findings in children with FAS and PEA overlap many of
those who display signs of autism spectrum disorder.

     Steinhausen et al. (1994) followed 158 children
over a fourteen-year period [9].  They found severity
of developmental problems and psychopathology was
greatest in the children with more prominent
dysmorphic features, but that these features often
disappear as a child grows older.  Males were more
severely affected than females especially in terms of
enuresis, speech disorders, stereotyped behaviors,
depression, and dependency.  Hyperkinetic disorder
was pronounced in both sexes and speech disorders
most serious in the most severely affected children.

     In the group of children followed by Iosub et al.
(1981), hyperactivity was evident in 74 percent, and
delayed speech in 80 percent.  Church et al. (1997)
studied 22 FAS children with a special focus on
hearing and developmental language problems.  
Conductive hearing loss due to recurrent serous otitis
media occurred in 17 children, and 6 children had
measurable sensorineural hearing loss.  Two of the
children with conductive hearing loss exhibited
echolalia, repetitive play, and self-stimulating
behaviors which Church et al. termed autistic
tendencies.  Twelve subjects could be tested for
central auditory processing deficits, and all were
classified as abnormal.
  1. Roebuck TM et al. (1998) A
    review of the
    neuroanatomical findings in
    children with fetal alcohol
    syndrome or prenatal
    exposure to alcohol.
  2. Nanson JL (1992) Autism in
    fetal alcohol syndrome: a
    report of six cases.
  3. Harris SR et al. (1995)
    Autistic behaviors in offspring
    of mothers abusing alcohol
    and other drugs: a series of
    case reports.
  4. Aronson M et al.  (1997)
    Attention deficits and autistic
    spectrum problems in
    children exposed to alcohol
    during gestation: a follow-up
    study.
  5. Church MW et al. (1997)
    Hearing, language, speech,
    vestibular, and dentofacial
    disorders in fetal alcohol
    syndrome.
  6. Davis E et al. (1992) Autism
    and developmental
    abnormalities in children
    with perinatal cocaine
    exposure.
  7. Iosub S et al. (1981) Fetal
    alcohol syndrome revisited.  
  8. Jones KL, Smith DW (1973)
    Recognition of the fetal
    alcohol syndrome in early
    infancy.
  9. Steinhausen H-C et al.  
    (1994). Correlates of
    psychopathology and
    intelligence in children with
    fetal alcohol syndrome.  
References
Full References
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  1. Roebuck TM, Mattson SN, Riley EP (1998) A review of the neuroanatomical findings in
    children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism,
    Clinical and Experimental Research 22:339-44.
  2. Nanson JL (1992) Autism in fetal alcohol syndrome: a report of six cases. Alcoholism,
    Clinical and Experimental Research 16:558-565.
  3. Harris SR, MacKay LL, Osborn JA (1995) Autistic behaviors in offspring of mothers
    abusing alcohol and other drugs: a series of case reports. Alcoholism, Clinical and
    Experimental Research 19:660-5
  4. Aronson M, Hagberg B, Gillberg C (1997) Attention deficits and autistic spectrum
    problems in children exposed to alcohol during gestation: a follow-up study.
    Developmental Medicine and Child Neurology 39:583-7.
  5. Church MW, Eldis F, Blakley BW, Bawle EV (1997) Hearing, language, speech,
    vestibular, and dentofacial disorders in fetal alcohol syndrome. Alcoholism, Clinical
    and Experimental Research 21:227-237.
  6. Davis E, Fennoy I, Laraque D, Kanem N, Brown G, Mitchell J (1992) Autism and
    developmental abnormalities in children with perinatal cocaine exposure. Journal of the
    National Medical Association 84: 315-319.
  7. Iosub S, Fuchs M, Bingol N, and Gromisch DS (1981) Fetal alcohol syndrome revisited.  
    Pediatrics 68:475-479.
  8. Jones KL, Smith DW (1973) Recognition of the fetal alcohol syndrome in early infancy.
    Lancet Nov 3;2(7836):999-1001.
  9. Steinhausen H-C, Willms J, and Spohr H-L (1994). Correlates of psychopathology and
    intelligence in children with fetal alcohol syndrome.  Journal of Child Psychology and
    Psychiatry 35:323-331.